Senior Data Mining Analyst

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $125k - $135k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Machinify

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 $10M Series A - Machinify on 2018-10

Healthcare • Consulting • Logistics

Machinify is a healthcare-focused AI platform and services company that reshapes healthcare payments and payment integrity. Its AI operating system unifies claims, medical records, contracts, and policies, and uses foundation models and task-specific agents to automate and improve coding, payment accuracy, recoveries, and cost avoidance. Machinify serves health plans (including 18 of the top 20), supports insourced, hybrid, or fully-managed deployments, and emphasizes measurable outcomes — reporting 85+ customers, 270M member lives covered, and $6B+ in annual cost avoidance and recoveries.

📋 Description

• Lead pre and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise. • Analyze and interpret provider contracts to ensure payments align with negotiated terms, methodologies, and payer rules. • Collaborate closely with engineering and data science teams to translate business and reimbursement logic into analytical and automation frameworks. • Research and document emerging reimbursement and contract patterns, coverage rules, and billing practices to inform concept development. • Translate complex reimbursement and contract scenarios into structured rules and business logic for implementation. • Analyze claim-level data to pinpoint root causes of overpayments or incorrect denials and recommend corrective approaches. • Maintain expertise on CMS and commercial payer reimbursement guidelines. • Support quality review, concept validation, and process improvement initiatives.

🎯 Requirements

• 5+ years of experience in healthcare data mining or claims editing on the provider, payer, or vendor side. • Deep understanding of provider contracts, including rate structures, carve-outs, and reimbursement methodologies. • Strong knowledge of claims processing, coding, billing, and payment logic across CMS and commercial payers. • Proven ability to identify improper payment patterns, root causes, and opportunities for correction. • Strong investigative and deductive reasoning skills; able to connect policy, data, and contractual details. • Comfortable working in close collaboration with technical teams to guide implementation of business logic. • Self-directed, detail-oriented, and adaptable to a fast-paced, growing environment. • Coding certification (e.g., CPC, CCS, or equivalent) preferred. • Working proficiency in SQL for data exploration and validation preferred. • Prior experience in cross-functional R&D or innovation teams focused on healthcare payment integrity preferred.

🏖️ Benefits

• Work from anywhere in the US! Machinify is digital-first. • Top Medical/Dental/Vision offerings • FSA/HSA • Tuition reimbursement • Competitive salary • 401(k) with company match • Additional health and wellness benefits and perks • Flexible and trusting environment where you’ll feel empowered to do your best work

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